Scarring
Advanced keratoconus with scarring, severe deformation or insufficient functional vision despite spectacles or contact lenses. Stromal scars and opacities after infection, trauma or burns when the damage substantially reduces vision.
Almaty
Astana, Shymkent
Keratoplasty (corneal transplantation)
Price after consultation
About the service
Keratoplasty replaces damaged corneal layers with donor tissue. The transplant type depends on the depth of disease, with preparation and long-term follow-up planned individually.
Who the service is for
Corneal condition
Inherited or acquired corneal dystrophy with irreversible loss of transparency.
Endothelial cells
Endothelial failure, including bullous keratopathy, where edema is driven by inadequate endothelial function.
Previous treatment
A failed or permanently cloudy previous graft when repeat transplantation is being considered.
Assessment before choosing treatment
Until KazRIED officially confirms resumption of transplantation, use the consultation to clarify diagnosis, indication, alternatives and the current care pathway.
Eye injury
Corneal ulceration, melting or perforation where therapeutic or tectonic surgery is considered to maintain ocular integrity.
Assessing benefits and risks
Keratoplasty requires a separate risk assessment.
Prescribed medicines
List all ocular and systemic medicines.
Do not change medicines yourself
Do not stop steroids, antivirals, pressure-lowering drops or other prescribed treatment on your own.
Corneal condition
KazRIED currently publicly reports that corneal transplantation at the institute has been suspended.
Anterior-segment examination
Bring medical reports, records of previous operations, biomicroscopy results, corneal topography or tomography, pachymetry, endothelial microscopy and anterior-segment OCT results if performed.
Control of intraocular inflammation
Tell the surgeon about herpetic keratitis, ocular trauma or burns, previous grafts, glaucoma , uveitis and previous lens or retinal surgery. These factors can change risk and technique.
Contact lenses
If you use contact or scleral lenses, ask when to discontinue them before corneal measurements.
When urgent care is needed
Pain, photophobia, redness and rapidly decreasing vision should not wait for a routine visit because active keratitis, ulceration or another urgent problem may be present. After any corneal transplant, reduced vision, pain, redness and photophobia require urgent assessment to exclude rejection, infection or another complication.
When urgent care is needed
Active inflammation, infection, marked corneal vascularisation, uncontrolled glaucoma, severe ocular-surface disease, previous failed grafts and other associated conditions may worsen the prognosis or change the urgency and type of surgery.
Limitations and safety
Keratoplasty requires individualized risk assessment.
Book a consultation
Stages
Stage 1
Surgical consultation
The clinician defines the cause of corneal damage and whether the goal would be optical, therapeutic or tectonic.
Stage 2
Corneal and ocular diagnostics.
Transparency, thickness, shape, endothelial status, intraocular pressure and the anterior and posterior segments are assessed as indicated.
Stage 3
Layer selection.
The surgeon determines whether healthy recipient layers can be preserved or full-thickness replacement is required.
Stage 4
Preoperative preparation
The required tests and specialist consultations are determined by the current KazRIED protocol and type of anaesthesia.
Stage 5
Donor tissue and scheduling
This depends on the legal and organizational transplantation pathway.
Stage 6
Surgery.
Diseased tissue is removed in full or selectively and replaced with prepared donor tissue; fixation depends on the technique.
Stage 7
Long-term follow-up.
Graft clarity, intraocular pressure, sutures or endothelial graft position, refraction and signs of immune reaction are monitored.
Service benefits
Replacement of damaged tissue
When indicated, keratoplasty allows diseased corneal tissue to be replaced with a donor graft.
An opportunity to improve transparency
When the cornea is opaque, transplantation can restore light transmission and improve vision within the eye's capabilities.
Consideration of affected layers
Assessing the depth of changes helps select an appropriate method, including lamellar or full-thickness transplantation when indicated.
Supporting the eye's integrity
In selected severe conditions, transplantation is used to restore or preserve corneal structure.
Methods comparison · 1
Criterion
DALK
DMEK / DSAEK
Penetrating PK
Tissue replaced
Anterior stroma; recipient Descemet membrane and endothelium are retained
Posterior layers: endothelium and Descemet membrane, with thin stroma in DSAEK
Full corneal thickness
Typical anatomy
Anterior or stromal disease with healthy endothelium
Endothelial failure with relatively healthy anterior stroma
Full-thickness disease or selective surgery not feasible
Keratoconus
Often relevant in advanced keratoconus with healthy endothelium
Not designed for keratoconus with normal endothelium
Option for full-thickness scarring, complex anatomy or inability to complete DALK
Endothelial rejection
Recipient endothelium is preserved, lowering endothelial rejection risk
Immune reaction to donor endothelium remains possible
Higher rejection exposure because full-thickness donor tissue is used
Anterior chamber opened
Ideally no
Yes, graft is inserted into the anterior chamber
Yes, open-sky procedure
Sutures
Corneal sutures are usually used
Main fixation is with air or gas; fewer corneal sutures
Corneal sutures are central to wound fixation
Recovery
Depends on interface and astigmatism; not immediate
Often faster, but graft detachment may require repeat injection of air or gas.
Usually longer because of sutures and refractive change
DALK
Tissue replaced
Typical anatomy
Keratoconus
Endothelial rejection
Anterior chamber opened
Sutures
Recovery
Anterior stroma; recipient Descemet membrane and endothelium are retained
Anterior or stromal disease with healthy endothelium
Often relevant in advanced keratoconus with healthy endothelium
Recipient endothelium is preserved, lowering endothelial rejection risk
Ideally no
Corneal sutures are usually used
Depends on interface and astigmatism; not immediate
Posterior layers: endothelium and Descemet membrane, with thin stroma in DSAEK
Endothelial failure with relatively healthy anterior stroma
Not designed for keratoconus with normal endothelium
Immune reaction to donor endothelium remains possible
Yes, graft is inserted into the anterior chamber
Main fixation is with air or gas; fewer corneal sutures
Often faster, but graft detachment may require repeat injection of air or gas.
Full corneal thickness
Full-thickness disease or selective surgery not feasible
Option for full-thickness scarring, complex anatomy or inability to complete DALK
Higher rejection exposure because full-thickness donor tissue is used
Yes, open-sky procedure
Corneal sutures are central to wound fixation
Usually longer because of sutures and refractive change
Methods comparison · 2
Clinical situation
Keratoconus without marked scarring
Keratoconus with deep stromal disease and healthy endothelium
Endothelial dystrophy / bullous keratopathy
Full-thickness scar or complex disease
Ulcer, melt or perforation
Primary goal
Stabilize disease and provide functional optical correction
Replace diseased stroma
Restore endothelial pump function
Restore transparency or anatomy of the full cornea
Preserve globe integrity and control tissue destruction
Most relevant pathway
Cross-linking / lenses as indicated
DALK
DMEK / DSAEK
Penetrating PK
Therapeutic / tectonic keratoplasty
Keratoconus without marked scarring
Primary goal
Most relevant pathway
Stabilize disease and provide functional optical correction
Cross-linking / lenses as indicated
Replace diseased stroma
DALK
Restore endothelial pump function
DMEK / DSAEK
Restore transparency or anatomy of the full cornea
Penetrating PK
Preserve globe integrity and control tissue destruction
Therapeutic / tectonic keratoplasty
Book an appointment
Book a KazRIED ophthalmic-surgeon consultation to define the depth and cause of corneal disease, determine whether transplantation is truly indicated, discuss alternatives and clarify the current treatment pathway.
Procedure prices
Service name
Price
Keratoplasty / corneal transplantation
Cost determined after consultation
Our doctors
A team of experienced doctors across specialties.
Experience: 26 years
Head
Zhakybekov Ruslan Adilovich
Candidate of Medical Sciences; Highest-category ophthalmologist
Experience: 32 years
Sabyrbaev Nurlan Berdauletovich
Candidate of Medical Sciences; Highest-category ophthalmologist
Experience: 13 years
Ophthalmologist
Kalshabekov Alibi Sembaevich
Highest-category ophthalmologist
Experience: 9 years
Ophthalmologist
Kalmurzaev Kanat Kayratuly
Second-category ophthalmologist
Experience: 10 years
Ophthalmologist
Kazankapov Gumarzhan Kuanyshevich
Keratoplasty: when corneal transplantation is needed and how the method is selected
The cornea must be transparent and regularly shaped to transmit and focus light. With significant scarring, dystrophy, keratoconus, edema caused by endothelial failure, or tissue destruction, medications, lenses, and surface surgery may not resolve the underlying problem.
In these situations, keratoplasty — transplantation of the cornea or selected corneal layers — may be considered.
How is the type of keratoplasty selected?
The modern principle is to replace only the irreversibly damaged layers. Selection depends on a layer-specific corneal assessment and the condition of the entire eye.
- Deep anterior lamellar keratoplasty (DALK) may be considered for deep stromal disease when the patient’s own endothelium is preserved and surgery is technically feasible. Preserving the endothelium reduces the risk of endothelial rejection.
- Endothelial keratoplasty (DMEK/DSAEK) may be used when the endothelium is primarily affected, for example in endothelial dystrophy or bullous keratopathy. It preserves healthy anterior stroma when the method is available and anatomically suitable.
- Penetrating keratoplasty remains an option for full-thickness scarring or complex disease. It involves a greater suture-related and immunological burden.
What are the possible goals of surgery?
Optical keratoplasty aims to restore transparency and create the conditions for better vision.
Therapeutic or tectonic keratoplasty may be needed to control an infectious destructive process, close a corneal defect, and preserve the eye.
With an ulcer, corneal melting, or threatened perforation, preserving the integrity of the eye takes priority. Visual rehabilitation may be planned later.
Does keratoconus always require transplantation?
Keratoplasty is not automatically the first step for keratoconus without significant scarring.
If the disease has progressed but the central cornea remains clear, the clinician first assesses whether stabilization and optical correction options have been exhausted.
What if a previous graft loses transparency?
The cause must first be identified: rejection, endothelial failure, infection, recurrence of the underlying disease, or another problem. This determines further management and whether another procedure is needed.
What determines the outcome?
The outcome depends on more than graft transparency. Important factors include:
- the condition of the retina and optic nerve;
- glaucoma;
- corneal blood vessels and inflammation;
- astigmatism;
- previous operations;
- the ability to follow a long-term treatment and monitoring plan.
The method is selected according to which layer is irreversibly damaged. Patients need a precise layer-specific corneal assessment and evaluation of the entire eye.
Facts and offers
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Related services
Frequently asked questions
What is keratoplasty?
Keratoplasty is surgery in which diseased corneal tissue is replaced with donor tissue, either through the full thickness or selectively by layers. The goal may be to restore corneal clarity and vision or preserve structural integrity in severe corneal disease.
When may a corneal transplant be needed?
It may be considered when disease causes significant opacity, scarring, deformation, endothelial failure, thinning or threatened corneal integrity and less invasive treatment cannot provide an adequate result.
Why may keratoplasty be needed for keratoconus?
Advanced keratoconus can cause severe corneal deformation, thinning and scarring, while spectacles or contact lenses may no longer provide functional vision. Keratoplasty may then be considered.
How does penetrating keratoplasty differ from lamellar keratoplasty?
Penetrating keratoplasty replaces the full corneal thickness. Lamellar techniques replace only the diseased layers and preserve healthy recipient tissue whenever possible.
What is DALK?
Deep anterior lamellar keratoplasty removes diseased corneal stroma while preserving the recipient's Descemet membrane and endothelium. It is particularly useful for anterior stromal disease with healthy endothelium, including many cases of keratoconus.
What are DMEK and DSAEK?
They are endothelial keratoplasty techniques. DMEK transplants donor Descemet membrane and endothelium, while DSAEK additionally includes a thin layer of posterior donor stroma. They are primarily used for corneal endothelial failure.
Which is best: DALK, DMEK, DSAEK or penetrating keratoplasty?
There is no universally best technique. Selection depends on which corneal layer is diseased. DALK is mainly used for anterior stromal disease with healthy endothelium, DMEK and DSAEK for endothelial failure and penetrating keratoplasty when full-thickness replacement is needed.
Can vision improve after corneal transplantation?
Optical keratoplasty can substantially improve vision when corneal disease is the main cause of visual loss. Outcome also depends on retinal and optic-nerve health, residual astigmatism, healing and graft health. Full visual recovery cannot be guaranteed.
What is therapeutic or tectonic keratoplasty?
Its primary goal is not necessarily visual improvement but to control corneal tissue destruction, close a defect and preserve ocular integrity. It may be required for severe ulceration, corneal melting, descemetocele or perforation.
Where does donor corneal tissue come from?
Donor tissue is obtained through regulated donation and eye-bank systems. Donor history, infectious-disease screening, tissue processing, storage and suitability are assessed before transplantation. Exact requirements depend on national regulations.